Provider Demographics
NPI:1780686071
Name:ANDRADE, RIOLIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:RIOLIN
Middle Name:C
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MARYS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-706-3491
Mailing Address - Fax:845-338-3088
Practice Address - Street 1:117 MARY'S AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-338-5555
Practice Address - Fax:845-338-2404
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165872-1174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948545Medicaid
A63726Medicare UPIN
NY00948545Medicaid
67D361Medicare PIN